Influenza vaccine coverage among health care workers in Victorian public hospitals

Ann L Bull, Noleen Bennett, Helen C Pitcher, Philip L Russo and Michael J Richards
Med J Aust 2007; 186 (4): 185-186. || doi: 10.5694/j.1326-5377.2007.tb00858.x
Published online: 19 February 2007

Our results suggest that influenza vaccine uptake in HCWs in Victorian public hospitals is low. This finding is consistent with reports from other parts of the world,5-8 and highlights the need for ongoing campaigns to ensure HCWs are targeted.

Evidence that vaccination of HCWs is safe and effective, and prevents a significant number of influenza infections, hospitalisations and deaths among patients is compelling.9-13 Vaccination of HCWs has been associated with decreased mortality in long-term care from 22.4% to 13.6%,13 and reduced absences from work due to illness.9,12

The demonstrated benefits of vaccination have led to discussion in the United States regarding the introduction of mandatory annual influenza vaccines for HCWs unless there is a medical contraindication or religious objection, or an informed refusal is signed.14 One of the US national health objectives for 2010 is to achieve 60% vaccination in HCWs.4

In this study, non-clinical staff had higher levels of vaccination than clinical staff. Previous studies have shown influenza vaccination among HCWs is affected by factors such as knowledge of influenza vaccine,15 age and race,7 and vaccination among physicians is higher than among nursing staff.15-17

Importantly, education regarding influenza vaccination has been shown to increase uptake in HCWs.16 This is not surprising, given that, in one study, 31% of resident physicians at a teaching hospital believed that influenza vaccine could cause influenza.18

We also found higher uptake of influenza vaccine in hospitals with < 100 beds. The reasons for this are unclear, however, anecdotal evidence suggests there may be easier access to vaccination, more accurate data collection with smaller numbers, or older staff in these hospitals.

Limitations mainly concern difficulties collecting high quality, accurate data. Some hospitals could only supply categorical data at the health service level rather than hospital campus level. Exact methods of data collection may also have varied at different hospitals. Some staff, particularly medical staff, may work at more than one campus. The most likely effect of this is that they may be counted twice in the denominator and only once in the numerator (at the place where they were vaccinated). Other staff may be vaccinated privately. This would tend to underestimate vaccine uptake.

There is no guarantee that casual staff were completely excluded. In some facilities, casual staff also receive vaccinations.

To eliminate these problems, data for individuals would need to be collected and all staff accounted for. This would be resource-intensive. Difficulties with measuring HCW vaccinations have previously been recognised,19 and there is no simple solution. We believe the method used here is sufficient to provide information for practical purposes.

Our data represent the first published data on HCW vaccination levels in Victorian public hospitals, and provide a baseline from which to work at increasing vaccination uptake in the future. In the light of all of the evidence for benefits of influenza vaccination for HCWs, we believe it is important to continue to collect and use these data. These data should be available to underpin ongoing efforts to improve vaccination uptake in HCWs and to ensure that Victorian hospitals aim to meet, if not exceed, international standards and recommendations.

Received 23 August 2006, accepted 6 November 2006

  • Ann L Bull1
  • Noleen Bennett1
  • Helen C Pitcher2
  • Philip L Russo1
  • Michael J Richards1

  • 1 VICNISS Coordinating Centre, Melbourne, VIC.
  • 2 Disease Prevention and Control, Department of Human Services, Melbourne, VIC.



The VICNISS Coordinating Centre would like to thank all Infection Control Consultants and their teams at participating hospitals in collecting these data. Without the cooperation and commitment from this group, the VICNISS program would not be possible. The VICNISS program is fully funded by the Department of Human Services, Victoria. We wish to thank the Quality and Safety Branch, Department of Human Services, Victoria, and Melbourne Health. Thanks to Simon Burrell, Jane Motley and Kylie Berry at the VICNISS Coordinating Centre, and to Heath Kelly for comments on this manuscript.

Competing interests:

None identified.

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